NPIMap

Individual provider Active NPI

Brandy M McKenney, PA-C

  • Physician Assistant
  • Scarborough, ME
National Provider Identifier
1659458511
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-755 Issued in ME
Practice address
69 US Route 1
Scarborough, ME 04074-9374
Phone
(207) 883-8100
NPI assigned
Oct 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-755 ME Primary

Addresses

Primary practice location

69 US Route 1
Scarborough, ME 04074-9374

Mailing address

436 Bridge St
Westbrook, ME 04092-3185
Phone (207) 856-6455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070116000231 ME Practitioner - Physician Assistant 1557362662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy HospitalGroup PAC ID 6103737812, 307 clinicians

Practice addresses (Care Compare)

19 S Gorham Xing
Gorham, ME 04038-2690
Phone (207) 535-1400

40 Park Rd
Westbrook, ME 04092-3188
Phone (207) 857-8174

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-755MEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital CurrentSince Aug 26, 2013 Accepting new patients
Mercy Hospital Past Accepting new patients

Locations

931 Union St
Fl 3
Bangor, ME 04401

19 S Gorham Xing
Gorham, ME 04038
Phone (207) 535-1400

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 41

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 41

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659458511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 BRIDGE ST",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040923185",
            "telephone_number": "207-856-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 US ROUTE 1",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040749374",
            "telephone_number": "207-883-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENNEY",
        "first_name": "BRANDY",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA-755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scarborough, ME

Sources for this page

Verify at the official NPI Registry.